From the mailbox

This column was originally published in AMA eVoice on September 20, 2007. Dr. Davis is president of the American Medical Association.

I've received many interesting—and candid—e-mails from readers in response to some of my columns so far. I'd like to share portions of a few.

The AMA is supporting the State Children's Health Insurance Program (SCHIP). But an amendment in a version from the U.S. House of Representatives strongly prohibits physician investment in hospitals. This is wrong. Doctors should be able to invest in what they want like any citizen, and we can best take care of our patients in facilities we control. I urge the AMA to object strongly to this amendment.

The AMA opposes restrictions on physician-owned hospitals. We have serious concerns about that provision in the House legislation, as well as a few other provisions such as payment cuts and new requirements for imaging services, and authority for the Secretary of Health and Human Services to reduce payments for high-volume services. The AMA is aggressively lobbying for changes in the legislation to address those concerns.

Childhood obesity is at an all-time high, as are rates of diabetes and other obesity-related conditions. Part of the problem is that much of the food served in school lunch programs and other food assistance programs comes from commodity programs that are based on economic considerations, rather than health needs. The food that is purchased and sent to schools is often high in fat and cholesterol.

Many Americans would be much healthier if our society made more dietary decisions based on health needs rather than financial concerns. My employer—Henry Ford Health System—wrote recently to one of our U.S. senators in support of the bipartisan Child Nutrition Promotion and School Lunch Protection Act (S. 771/H.R. 1363), which would require food sold in schools to meet current nutrition standards. Passage of such legislation would be a step in the right direction.

I am so pleased to know of an interest in improving the food choices at medical meetings. … We need to set an example. I like the idea of exercise at meetings. I have been disappointed at food choices, especially at conferences.

I'm glad you agree. I received more feedback (mostly positive) on my column about healthy medical meetings and conferences than on any other I've written, so it's clear that I struck a chord. As I argued in that column, it's time to practice what we preach to our patients about diet and exercise.

I've also received considerable feedback for my writings on "the lighter side":

In my first column, I wrote about my license plate (AMA USA) and other physicians' vanity plates. One of our readers sent me a photo of his license plate, which reflects his response to the medical liability crisis: "NO MO OB."

In response to the poem I cited about influenza, a reader sent me an "Ode to the Bird Flu":

One flu
over
the cuckoo's nest.

Many readers wrote to thank me for my column on word oddities in medicine. One wrote:

I loved your sidebar on medical words. … As for that 45-letter word expanding "pneumoconiosis," when I worked at the National Institute for Occupational Safety and Health in the early 1980s and studied logging workers in the blown-down area around Mount St. Helens, I'm glad I didn't have to use that word in print. Back then we were still using typewriters.

My argument that the staff of Aesculapius is a more appropriate medical symbol than the caduceus of Hermes got me into a snake pit with some of our uniformed services. A colleague informed me that the caduceus is a time-honored symbol for the U.S. Army Medical Department. He gave me an interesting article from the December 1978 issue of Military Medicine, which traces the use of these symbols in the various uniformed services.

The caduceus also adorns the logo for the Commissioned Corps of the U.S. Public Health Service (in which I served for seven years), and is used in the Navy as well (e.g., by its hospital, nurse, and dental corps). Interestingly, the U.S. Air Force Medical Department has chosen the staff of Aesculapius as its badge of healing. Of course, I meant no disrespect to any uniformed service (or any other medical organization) that uses the caduceus. What matters most is their tireless devotion to improving and protecting the health of the people they serve.

Another reader offered his view of the origins of the staff of Aesculapius:

I have always believed that the snake wrapped around the staff, which is described as the staff of Aesculapius, has an entirely different origin, one that has nothing whatsoever to do with Greek mythology. We need look no further than the Bible. In Chapter 21 of the book of Numbers, we find an episode in which the Hebrew people, during their long exodus from Egypt to the Promised Land, have once again tried God's patience with their faithless complaining about their food and traveling conditions. So God taught them a lesson by sending "fiery serpents among the people," which bit many of them, often with fatal results.

When the people repented from sinning against God with their bitterness and bad attitude, Moses prayed to God, who instructed him to construct a brass serpent on a pole. Anyone who had been bitten by one of the poisonous snakes could then look upon the brass serpent on the pole and be healed. It was meant to remind the people that God intended them to look up to Him for their needs, and to be obedient to Moses, whom He had prepared as their leader during this period of time.

I thank the many readers who have sent me their comments, commendations, and complaints. I encourage you to write more. Sharing our ideas and opinions is one way we can change health care for the better.

Please send comments, questions, and replies to amaprez@ama-assn.org.